Treatment and rehabilitation of traumatized refugees (TR-REFUGEES)

• Aims of the study are:

• To gain increased knowledge of how psychological health, quality of life, and functioning in everyday life in Norway develop over time – before, during, and after mental health treatment in specialist services

• To gain knowledge about how pre-flight, flight, and post-flight personal history, potentially traumatic experiences, social and cultural factors relate to the participants’ health and well-being in their exile living 

• To investigate how the patients and the therapists experience the therapeutic process, and what promotes or hinders a beneficial therapeutic process

• To examine therapeutic processes in search of factors and interventions that relate to a positive treatment outcome

A naturalistic, qualitative and quantitative, longitudinal study.

Approvals: The project was approved by the Regional Ethics Committee REK, by the Data Protection Official, Norwegian Social Science Data Services.

The project is financed by NKVTS. The project has had 1.5 – 1.0 researchers during various periods.

Treatment and rehabilitation of traumatized refugees  (the umbrella project), 2006 – 2025.

– A prospective and naturalistic study of 54 patients with refugee and trauma backgrounds who were recruited consecutively as they were admitted to individual treatment in outpatient clinics or by psychiatrists and psychologists in solo- or ’private’ practices within the psychiatric specialist health care system. Therapy sessions were audio taped in the solo practices, but this turned out not to be feasible in the clinics. The objective with audiotaping was to study some treatment processes more closely.

The project began formal data collection in October 2006, and ended data collection in January 2018. The patients were interviewed up to eight times (each time including one to six interviews) over the course of up to ten years: Upon admission to treatment (T1), one year after our first contact with the patient (T2), three years after our first contact with the patient (T3), whenever treatment was discontinued (Tx), and for many, at additional 2-3 years intervals. At treatment start, we investigated demographics, family relations, personal history, traumatic experiences in childhood, adolescence, and adult years, flight history, experiences of coming to Norway as a refugee, factors pertaining to work and education, and language acquisition in exile. In addition, we assessed personality function, psychological and physical complaints, particularly PTSD, anxiety and depression, social difficulties, resources and interests. Furthermore, the patients and the therapists were interviewed about the treatment process. Questions were also asked about other relevant aspects of the patient’s life, and certain psychometric measurements were repeated. The repeated qualitative interviews and quantitative assessments at follow-ups recorded the changes or fluctuations in the participants’ mental health, well-being, and social situation. Our interviews have comprised 5 to 10 years of the participants’ lives, from treatment start, through treatment of various lengths, and on in life. Publishing from the study is ongoing.

Publications: See Norwegian Version.

Marianne Opaas’ doctoral degree project (Completed April 29., 2016): “Trauma, personality function, and posttraumatic reactions: A retrospective and prospective study of traumatized refugee patients”.

Main supervisor: Professor Ellen Hartmann, Institute of Psychology, University of Oslo, Norway.

Assisting supervisor: Sverre Varvin, Dr. Philos., MD, Norwegian Centre for Violence and Traumatic Stress Studies/since fall 2014: Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Oslo, Norway (HiOA).

– An investigation of the connection between background factors, personality function, symptoms of mental distress, quality of life, employment, exile language proficiency, and psychological treatment among the traumatized refugee patients of the main/umbrella study. The Rorschach method was central in the investigation of personality function, supplemented by and compared with a number of other investigative methods.

Findings:

In her thesis, Marianne Opaas and co-authors found that childhood adverse experiences were even more strongly related to their present suffering than more recent experiences of war, persecution and other human rights violations (HRVs). Moreover, we found two new Rorschach components or personality dimensions that characterized the way these individuals functioned under the relative stress of assessment: 1) ‘Trauma Response’, along a continuum from constricted (i.e., restrained or limited associative and emotional activity) to flooded (i.e., traumatic intrusions, emotional regulation problems, and logical breaches in thinking), and 2) ‘Reality Testing’, along a continuum from impaired to adequate perceptual reality testing (i.e., ability to notice ordinary aspects of the environment and perceive events and objects in ways that correspond with realities and the ways others perceive them). Perceptual Reality Testing was more strongly related to the participants’ overall mental health and well-being than the other, more trauma-specific variable.

At the three-year follow-up, the participants’ mean results showed statistically significant improvements in depression, anxiety, PTSD, and quality of life, but the individual variation in outcome was pronounced. At T3 most participants still qualified for a mental health diagnosis. Higher scores on the Reality Testing dimension continued to predict better functioning during follow-up. The problems with reality testing identified in this study were of an apparently trauma-based nature, not to be confused with the reality testing difficulties of psychotic patients.

Thesis

Marianne Opaas (2016). Trauma, personality function, and posttraumatic reactions: A retrospective and prospective study of traumatized refugees. Dissertation for the degree PhD, Institute of Psychology, University of Oslo. Permanent link to the dissertation:  http://urn.nb.no/URN:NBN:no-53824

Mehdi Farsbaf’s doctoral degree project (2012 –  discontinued in 2017): “Healing trauma: Curative processes in psychotherapy with traumatized refugees”.

Main supervisor: Sverre Varvin, Dr. Philos., MD, NKVTS, from 2014: HiOA.

Assistant supervisor: Erik Stänicke, Dr. Psychol, Associate Professor, University of Oslo (UiO).

Mehdi Farsbaf’s doctoral project was a prospective naturalistic study of the treatment processes of patients with refugee and traumatized backgrounds undergoing psychodynamically-oriented treatment by psychologists and psychiatrists in publicly funded ‘private practice’. The patients were part of the participants of the umbrella project. The project was terminated without completion in 2017. One publication may be forthcoming.